Chief Jackson’s Public Comment.
Chief Jackson appeared at the October 26, 2015 meeting to explain the Agreement between the TRS and Shamong Township. A complete and accurate explanation of the Agreement, its billing revenues and compliance with federal billing requirements is long overdue. Unfortunately, a complete explanation wasn’t provided.
Here’s what Chief Jackson said along with a grade for what he added to the public discussion of emergency medical services.
1. Chief Jackson: “The Agreement with Shamong was not a mutual aid agreement….The Agreement was over billing.”
Chief Jackson GRADE A. That’s exactly what the Shamong Agreement says and that’s what TTJ reported in the October 23, 2015 Post.
Committeeman Joe Barton GRADE A. Mr. Barton was the only Committee member who stated on the record that the agreement was a billing agreement.
Mayor Kim Brown GRADE F. By now, Mayor Brown should know what a mutual aid agreement looks like; she’s been in office since 2000. The Shamong Agreement looks nothing like one. And because she hedged by saying that she hadn’t had a chance to read the Agreement she showed herself to be “Unprepared” for a meeting she gets paid to attend.
2. Chief Jackson: “Essentially, what it [the Agreement] was and what it was set up for is that as we don’t balance bill our residents in this town, we’re allowed to do that for a mutual aid partner.”
Chief Jackson GRADE INCOMPLETE: This statement doesn’t square with what the TRS has said many times before.
When Chief Jackson and TRS President Wood explained their billing program to the Tabernacle Committee in January 2013, they said that the TRS wouldn’t have to bill Tabernacle residents for the unpaid balance (any amount not covered by insurance including copays and deductibles), if the Township contributed an amount that reasonably approximated it. They said that the need for this contribution is a federal requirement.
The Committee decided to make this annual contribution. As a result, all Tabernacle residents contribute to the payment of outstanding balances through their taxes. The Committee understood and intended that every non-resident would be billed for his or her unpaid balance.
The amount of the Township’s annual contribution is $70,000. I’ve previously pointed out to the Committee that the TRS hasn’t submitted records which show what the amount of uncollected funds in Tabernacle is. So we don’t know if the $70,000 contribution reasonably approximates them. The Township has contributed $70,000 to the Squad since 2009, before the billing program even started.
In its bid to do Southampton’s EMS work, the TRS also explained that Southampton Township had to make a contribution in order for TRS to avoid billing residents the balance not covered by insurance.
Where a municipality contracts with a private ambulance service for EMS, the ambulance service may waive out-of-pocket coinsurance costs only if the municipality makes payment to the ambulance service to cover the coinsurance otherwise owed by residents.
In March 2014, the TRS applied to the United States Department of Health and Human Services, Office of Inspector General (OIG), for its advisory opinion regarding billing. The application was signed by President Jamie Wood. TRS wanted assurance that its Tabernacle billing program met federal requirements.
TRS told the OIG that Tabernacle Township had:
…appropriated a portion of tax revenue which it received from its residents in order to provide an annual stipend to the Requestor [TRS].
It said that Tabernacle’s annual contribution was:
…reasonably calculated to cover the costs of copayments and deductibles…and [t]herefore, the Municipality [Tabernacle] had effectively assumed the responsibility for payment of copayments and deductibles.
The TRS also told the OIG that it fully bills people outside of Tabernacle for all copayments and deductibles.
Individuals who receive BLS services [Basic Life Support] from Requestor [TRS] and who are NOT Township residents are balanced billed for all copayment and deductible amounts (emphasis in original) (Page 4, Para. 3).
Similar statements about billing non-residents are made throughout the application. Based on what the TRS said, the OIG issued a favorable Advisory Opinion on October 6, 2014.
The problem is that the TRS hasn’t been billing Shamong residents for copayments and deductibles. According to its 2013 Financial Statement,
Any billings in excess of a patient’s insurance coverage are waived for residents of the Township of Tabernacle. Residents of Shamong and charity care cases are also not billed per agreements made by the board [emphasis added].
And Shamong Township wasn’t making any contributions to cover these costs.
Committeeman Barton saw that because the TRS wasn’t billing Shamong residents for the unpaid balance, and because Shamong Township made no contribution to cover these costs, Tabernacle residents were, in effect, paying them. He also realized that the TRS’s failure to bill and Shamong’s failure to contribute seemed inconsistent with what the TRS had said was a federal requirement. Mr. Barton forcefully raised these concerns at the September 28 meeting.
Neither Chief Jackson nor Squad President Jamie Wood addressed these concerns at the October 13, 2015 meeting, which they attended. Nor did Chief Jackson address them at the October 26 meeting when he spoke. Nor has Committeeman Barton mentioned them since. This part of the explanation is incomplete.
3. Chief Jackson: “The understanding with Shamong was that they were going [to be] billing within six months of us signing the Agreement.”
Chief Jackson GRADE F. Based on Shamong Township’s public discussions of the Agreement, its squad had no intention of billing. Shamong’s committee discussed the Agreement at its October 22, 2013 meeting. At the meeting, the Shamong squad representative said that the squad couldn’t bill because it wasn’t state certified and didn’t have sufficient personnel to run two certified EMTs on every call, as required by state law. There’s nothing in the recording of that meeting that mentions what Chief Jackson said. TTJ Readers can listen to the discussion beginning minute 6:32 and ending minute 18:26 on audio File 3.
4. Chief Jackson: “..we did not come to committee and say yes, this is what we did; I apologize for that, I was under the impression that in discussions we had mentioned it, obviously we didn’t explain it well enough.”
“The other reason why we didn’t come up and stand up and describe a lot of things that went on was unfortunately we were involved in litigation…there’s client attorney privileges, there’s the fifth amendment right, there’s self incrimination and all those things, so there‘s a lot of things that we weren’t going to put on the public record.”
Chief Jackson GRADE F. The Agreement was discussed in public by the Shamong Township Committee and was adopted by Shamong Township. It was always a public record. A discussion of the Agreement with Tabernacle Township wouldn’t have made it any more public than it already was.
By the way, the Chief wouldn’t be so uncertain about whether the Agreement had been mentioned in his discussions with the Committee if those discussions had occurred at a public meeting. This is because there’d be a public record. Readers will recall that the Committee and the Squad intentionally held roving chalkboard presentations to avoid the public meeting requirements. What more has to happen for them to stop meeting privately?
5. Chief Jackson: “It’s [the Agreement] is expired now.”
Chief Jackson GRADE F. The Agreement doesn’t expire; it renews automatically. Item 7 (Pages 5 and 6) says that the Agreement expires on December 31, 2014 but:
Thereafter shall renew for successive one(1) year terms unless either Party shall provide the other with written notice of its intention not to renew no later than thirty days prior to the expiration of the then existing term.
The Shamong Township clerk confirmed in August and November 2015 that the Agreement is self-renewing and is still in effect.
6. Chief Jackson: “I apologize for [having created] the issue. I didn’t attend any of the township meetings…I took a break. As you guys have lives and things to do, so do I. So there were a lot of meetings that I wasn’t here over the last couple of months.”
Chief Jackson GRADE F. Surely the TRS has a chain of command and delegation so that it can function 24/7/365. Everyone appreciates that Chief Jackson takes a break now and then. But when he’s away, his duties pass to other TRS officers.
TRS President Jamie Wood was very knowledgeable about the Shamong Agreement because she was the primary contact with Shamong Township. She is also very familiar with insurance billing programs. She and Chief Jackson presented the TRS’s insurance billing proposal to the Tabernacle Committee at the January 28, 2013 meeting. She made her own presentation to the Township on March 10, 2014; and she signed the TRS’s application for the OIG opinion on March 14, 2014. She certainly could’ve discussed the Shamong Agreement with Tabernacle in Chief Jackson’s absence.
Every Committee member GRADE F. First, they created an official relationship with the TRS without establishing any regular mechanism for communication, review or management. It’s not an overstatement to say that the Committee’s management plan is to give the TRS a check for $70,000, pay its expenses and tell it to come back in a year for more.
Because there isn’t a regular public channel for communication with the Squad, it’s no surprise that everyone at the Township now says that they didn’t know what the TRS was doing. If the Committee had required that the TRS appear and report regularly, which is the smallest of requirements, this excuse would be off the table.
Second, I’ve been asking questions about the Agreement for months, but not a single Committee member ever bothered to contact the TRS.
Administrator Doug Cramer GRADE F. As the Township Administrator, he’s almost the official liason with the TRS and surely deals with it on a regular basis. And his son is an officer in the Squad. He heard all of my questions about the Shamong Agreement, but, apparently, never mentioned them to Chief Jackson, another TRS officer or President Jamie Wood for their follow-up.
7. “Show Us The Money.”
The insurance billing revenues are the bottom line of this story. But Chief Jackson didn’t mention the billing revenues that TRS gets from Tabernacle, Shamong and any other townships.
Every township that does insurance billing earns a substantial amount of revenue that is used to reduce taxes. Tabernacle is the only township that funnels the insurance billings to its rescue squad and gives no revenue back to the taxpayers. Tabernacle is also the only township that doesn’t disclose how much the insurance billing generates.
Hiding the facts makes for bad public policy and poor management. The Committee should’ve insisted that Chief Jackson report the revenues, but didn’t.
Committeeman Joe Barton Falls Back Into Line.
After Chief Jackson’s remarks, Mr. Barton announced that he had met privately with the Chief and TRS President Wood. Committeeman Barton now said that it was all a misunderstanding and that all of the concerns that he expressed at the September 28 and October 13 meetings were caused by the Shamong Squad because it wasn’t as advanced as our Squad and delayed its billings.
I want to thank Chief Jackson and actually President Woods after we had got the document from Mrs. Brooks; uh I did meet with the chief and Jamie Wood over at the squad building for about an hour; they explained their position on why they did what they did and where they felt it was a misunderstanding. So I appreciate you coming out here now Chief and talking to the whole township committee about that and clearly to me it was done with good intention and it was all about the billing they unfortunately Shamong just didn’t have they weren’t as far as our squad, thank you for that Chief.
When Mr. Barton spoke at the September 28 meeting, he raised strong concerns about the TRS’s waiver of its out-of-pocket costs for Shamong; their use of Tabernacle’s assets for Shamong residents without any contribution from Shamong Township; and whether TRS complied with the federal billing requirements.
Mr. Barton seemed insistent on having a public discussion to address these issues. And when Mr. Lee and Mr. Yates expressed similar concerns, there was a glimmer that such a discussion might happen.
But Mr. Barton has now returned to the fold. After Chief Jackson had given his explanation, I told Mr. Barton that he didn’t have the whole story (see Items 2,3,5,7). He said he had the whole story. So I asked him how much money the TRS earned through insurance billings. He said he didn’t know. So much for having the whole story.
Committeemen Yates and Lee, who expressed the same concerns as Mr. Barton at the September 28 meeting, are also back in line. Mr. Lee has been silent; Mr. Yates, who said he had “1000 questions” about the Agreement hasn’t asked one. However, he has raised the bold idea of unifying the Fire Company and the Squad. More about this in the next post.
The next township meeting will be held November 9, 2015 at town hall.